James Kirkup is The Telegraph's Executive Editor (Politics). He was previously the Telegraph's Political Editor and has worked at Westminster since 2001.

Evening Briefing: Political Casualties

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The day today

Political casualty 1
Sir David Nicholson succumbed to the inevitable and announced that he will step down as Chief Executive of NHS England next year. He didn’t mention it by name, but his departure follows the Mid Staffs hospital, where critics say he bears some blame. Despite its huge and rising budget, the health service “can still sometimes fail patients”, he said regretfully. And when the NHS fails, people die. So will he waive some of his £2 million pension?

Political casualty 2
On a day when he wanted credit for calling for GPs to actually treat their patients as human beings (a shocking notion, surely), Jeremy Hunt found himself dragged to the Commons to talk about accident and emergency. Worryingly for the Health Secretary, the idea of a “crisis” in A&E seems to be sticking.

Aye do
Gay marriage looked set to come a step closer. The Marriage (Same Sex Couples) Bill is likely to get its third reading in the Commons later tonight, passing despite the opposition of around half the Conservative Party. After yesterday’s heated debate, complete with “aggressive homosexuals,” today’s proceedings have been almost sedate. All that remains is the minor matter of the House of Lords,

Loons, cont.
Jeremy Paxman of the BBC has suggested that he has heard senior members of the Conservative describing members of that party as swivel-eyed loons. At time of writing, no one has yet threatened to sue Mr Paxman.

Jam tomorrow
Alex Salmond, the Scottish First Minister, published an “economic strategy” for an independent Scotland. The new nation would have lower taxes, more jobs and attract much more international investment, while keeping the pound and agreeing to take on £92 billion of the UK’s national debt. The sun would shine more too. (Note: one or more of these claims is false.)

Squeeze eases
Inflation fell to a mere 2.4 per cent in March. That was lower than expected by City types, who now believe that price-pressure on household finances is “set to wane”. Will the Coalition bother to tell anyone about another sign that the economy is picking up? Don’t hold your breath.

The departure of Sir David Nicholson was predictable, and predicted. Readers of Telegraph Politics knew more than two months ago that Whitehall was at work on the plan that was announced today.

That inevitability makes it curious that David Cameron and others were so keen to defend Sir David earlier in the year when the Mid Staffs scandal was flaring up once more.

Perhaps that instinct to defend is understandable: the PM is cautious about doing anything that looks like he is less than 100 per cent supportive of the health service.
Yet Sir David’s departure looks like the most dramatic confirmation yet that all is far from right in the NHS.

The fact that the service “can still fail patients” despite steady rises in its budget may just reopen debate about whether more money means better care; the ripples from Sir David’s departure may even reach the Spending Review, where the continued “ringfence” around the health budget seriously limits George Osborne’s room for manoeuvre.

Politically, the search for a new NHS chief must now be somewhere near the top of the Coalition’s priority list. Early names in the frame are Simon Stevens and Mark Britnell, former Whitehall types now both in the private sector, but ministers will search far and wide to ensure they get the very best.

For whoever gets the job won’t just oversee a £110 billion organisation that treats millions of people every day. That person will also help determine the outcome of the next general election.

Yes, the importance of immigration is high, and rising, but if there are two issues that most reliably top the list of public concerns, they are the economy and the NHS.
On the economy, ministers have made their big decisions and must now stick to them. If there is scope for more action, it now rests mainly with Mark Carney, the new Governor of the Bank of England.

And since the Coalition’s reforms of the NHS took effect last month, ministers’ sway over the health service has fallen sharply: Mr Hunt is engaged in the slow, difficult task of re-educating voters to see ministers as the critical overseers of the NHS, not its managers.

The day-to-day performance of the NHS, meanwhile, will be firmly in the control of Sir David’s replacement. To a significant degree, then, the fate of the Coalition will be in the hands of two unelected officials running national institutions.

Want to read more about the departure of the man they call D-Nic? Try these:

Pollsters beware. Not satisfied with tormenting the political class, the splendid Michael Deacon is now turning his attention to the psephologists and wondering whether millions of people have forgotten that they are Ukip supporters.